Performance Measures for CAD & Hypertension

Performance Measures for CAD & Hypertension

During the past decade, there has been increased awareness of the need to improve the quality of care delivered to patients with coronary artery disease (CAD) and hypertension. In keeping consistent with this focus, the American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) have developed guidelines and related performance measures that focus on these areas of care. In the July 12, 2011 issue of Circulation, the ACCF and AHA revised their original performance measures for adults with CAD and hypertension, which were developed in conjunction with the Physician Consortium for Performance Improvement (PCPI) and previously released in 2005. More Than a “Routine” Update for CAD & Hypertension With a general policy to revise performance measures no more than every 3 years, the AHA, ACCF, and PCPI had been working on revising the measurement sets for more than a year before they were published. “These new measurements represent a change in the science and methodology of how per­formance measures are typically developed,” says Joseph Drozda, Jr, MD, FACC, who co-chaired the PCPI panel. “The new mea­surements bring a focus on the outcomes of treatment rather than purely measures of process. We’re focusing on the things that make a difference and doing it in a way that will allow physicians to track their own per­formance in these key areas.” The 2011 ACCF/AHA performance measure sets consist of 10 total measures derived from several professional guidelines. It includes revisions to measures that were released in the 2005 document and five new measures (Table 1). “There are robust guidelines for CAD, supported by strong levels of evidence with respect...

Helpful Guidelines for Heart Health in Diabetes

This Physician’s Weekly feature covering guidelines for heart health in diabetes was completed in cooperation with the experts at the American Diabetes Association. Research has shown that patients with diabetes are at two to four times greater risk of suffering cardiovascular disease (CVD) events when compared with patients who do not have diabetes. Several mechanisms have been linked to the increased CVD risk in people with diabetes, including increased intracoronary thrombus formation, elevated platelet reactivity, and worsened endothelial dysfunction. “Aspirin has been shown to be effective in reducing cardiovascular morbidity and mortality in high-risk patients with heart attack or stroke,” explains Craig D. Williams, PharmD. “However, there has been some confusion surrounding the use of aspirin in patients who do not yet have CVD. That confusion is even greater among patients with diabetes.” In 2007, the American Diabetes Association and the American Heart Association (AHA) jointly recommended that aspirin be used as a primary prevention strategy in patients with diabetes who are at increased cardiovascular risk. This patient group includes those who are older than 40 or who have additional risk factors, such as a family history of CVD, hypertension, smoking, dyslipidemia, or albuminuria. “These recommendations were derived from older trials that included fewer patients with diabetes,” says Dr. Williams. “We now have results from two recent randomized controlled trials—the Japanese Primary Prevention of Atherosclerosis with Aspirin for Diabetes and the Prevention of Progression of Arterial Disease and Diabetes trials—in which aspirin use was examined specifically in patients with diabetes. These studies provide important insights on the efficacy of aspirin for primary prevention in diabetes, but they have also...